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CMS Finalizes Rule for Automatic Re-Enrollment in 2015 Health Plans

Sept. 2 — Consumers in the Affordable Care Act health insurance marketplace operated by the federal government will be able to automatically re-enroll in coverage for 2015 under a final rule issued Sept. 2 by the Centers for Medicare & Medicaid Services.

The rule (CMS-9941-F) finalizes a proposed rule issued June 26. It is scheduled to be published in the Federal Register Sept. 5 and is effective 30 days from that date.

Consumers in the federally facilitated marketplace will receive notices shortly before open enrollment begins for 2015, according to a fact sheet issued by the CMS. The notices will explain the “auto-enrollment” process and how consumers can see if they qualify for additional financial assistance and shop for plans, it said. Consumers will also receive notices from their insurance company about 2015 premiums and how much they may save with premium tax credits, it said. Open enrollment begins Nov. 15.

If consumers do nothing, they will be automatically enrolled in the same plan with the same premium tax credits and other financial assistance, if applicable, as in the 2014 plan year, the fact sheet said.

“Consumers are encouraged to return to the Marketplace to make sure they are getting all the financial assistance they qualify for, and to shop for the plan that best suits their needs,” the fact sheet said.

Automatic Enrollment Without Assistance

Consumers whose 2013 tax return indicates they had “very high income” or who didn't give the marketplace permission to check updated tax information for annual eligibility redetermination purposes will be enrolled automatically without financial assistance, if they don't return to the federal HealthCare.gov website, the fact sheet said. “This process will help provide continuity of coverage and safeguard taxpayer dollars,” it said.

State-based marketplaces will have the flexibility to propose “unique approaches” to the process, the fact sheet said.

“We are committed to providing a simple, familiar process for consumers to renew their coverage next year,” CMS Administrator Marilyn Tavenner said in the fact sheet. “Consumers should use this time to evaluate their health needs, browse other options, and see if they qualify for additional financial assistance. However, consumers who are happy with their plan and have no changes to their income or family situation can be auto-enrolled in their same plan next year, similar to how it is done in the employer insurance market today.”

Researchers have warned that many consumers who are automatically re-enrolled in plans for 2015 may receive lower subsidies than they would if they went through a redetermination process. In comments on the proposed rule, health insurers and hospitals supported the idea of automatic re-enrollment, saying consumers should have a streamlined process to update their income and eligibility information for advance premium tax credits without having to go through the entire application process.

A notice sent to Capitol Hill health staff said guidance on final issuer notices was to be posted later Sept. 2.

To contact the reporter on this story: Sara Hansard in Washington at shansard@bna.com

To contact the editor responsible for this story: Janey Cohen at jcohen@bna.com

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